불안정성 대퇴골 전자부 골절에서 시멘트형 주대와 무시멘트 주대를 이용한 인공관절 반치환술의 수술 후 출혈량 및 합병증 비교 - 선택적 시멘트형 주대 사용의 유용성 -
Comparison of Postoperative Bleeding and Complications between Cemented and Non-cemented Bipolar Hemiarthroplasty in Treatment of Unstable Pertrochanteric Fracture
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목적: 고령의 불안정성 대퇴골 전자부 골절 환자에서 인공관절 반치환술을 시행하는 경우에, 시멘트형 주대를 사용한 그룹과 무시멘트 주대를 사용한 그룹의 수술 후 출혈량과 합병증을 비교 분석하였다. 대상 및 방법: 3년 10개월 간(2008년 1월-2011년 10월) 본원에서 불안정성 대퇴 전자부 골절로 인공 관절 반치환술을 받은 환자 104명을 대상으로 하였고, 시멘트형 주대를 사용한 64명을 제1군, 무시멘트형 주대를 사용한 40명을 제2군으로 분류하였다. 수술 전에 대퇴골 근위부의 골질을 평가하여 어떤 형태의 주대를 사용할지 결정하였고, 두 군의 수술 후 출혈량과 합병증을 조사하였다. 추가로, 환자의 INR 수치와 BMI 값에 따른 수술 후 출혈량의 차이가 있는지 여부에 대해 조사하였다. 결과:‘ 수술 중 출혈 예상량’은 제1군이 평균 389.8 cc, 제2군이 평균 395.3 cc로 차이가 없었고(P=0.88),‘ 수술 후 배액된 출혈량’은 제1군이 219.6 cc, 제2군이 338.1 cc로, 시멘트형 주대를 사용한 제1군이 유의하게 출혈량이 적었다(P=0.004). 수술 소요 시간은 제1군과 2군이 각각 평균 96분과 72분으로, 유의한 차이가 없었다(P=0.85). 한편, ‘수술 후 배액된 출혈량’은 INR (international normalized ratio) 수치나 BMI (body mass index)값에 따라 차이가 나지 않았다(P=0.28, P=0.08). 저혈압성 쇼크나 폐색전증 등의 합병증은 양군 모두에서 없었고, 제2군에서는 인공삽입물 주변부 골절이 3예 발생하였다. 결론: 대퇴골 전자부 골절 환자에서 인공관절 반치환술을 시행할 때, 시멘트형 주대를 사용할 경우 무시멘트형 주대를 사용할 때보다 수술 후 출혈량이 적었고 합병증도 적었다. 수술 전 골질을 평가하여 시멘트형 주대를 선택적으로 사용하는 것은 합병증을 줄일 수 있는 좋은 치료 방법이다.
Abstract
Purpose: In cases of patients who underwent bipolar hemiarthroplasty (BPHA) for treatment of a pertrochanteric fracture, we compared and analyzed the amount of blood loss and complications between a group using the cemented stem and a group using the cementless stem. Materials and Methods: A total of 104 patients who underwent BPHA for treatment of a pertrochanteric fracture in our hospital for three years and 10 months (From January 2008 to October 2011) were included in this study. Among the 104 patients, 64 patients with a cemented stem were categorized into group 1, and the other 40 patients with an uncemented stem were categorized into group 2. Before surgery, the type of stem was determined by the bone quality of the proximal femur, which had been evaluated with a simple X-ray. Then, after surgery, the amount of blood loss and complications were compared between the two groups. Results: Expected blood loss during the operation was 389.8 cc in group 1, and 395.3 cc in group 2(P=0.88). Postoperatively, average drained blood loss was 219.6 cc in group 1, and 338.1 cc in group 2. Cemented stem was associated with significantly less blood loss (P=0.004). The average operation time in group 1 and in group 2 was 96 minutes and 72 minutes. There was no significant difference in operating time (P=0.85). In addition,there was no difference in INR (International Normalized Ratio) and BMI (Body Mass Index) (P=0.28 and 0.08) regarding total amount of postoperatively drained blood loss. There was no occurrence of hypotensive shock or fatal pulmonary embolism in either group. Three cases of periprosthetic fracture occurred in group 2. Conclusion: Fewer occurrences of postoperative blood loss and fewer complications were observed in the cemented stem group than in the cementless stem group. Preoperative evaluation of bone quality and use of the cement stem for patients with poor bone quality may be a good treatment method that can help to reduce complications.
참고문헌 (13)
- Dhanwal DK, "Epidemiology of hip fracture : Worldwide geographic variation", Indian J Orthop, 45, pp.15~22 (2011)
- Kim WY, "Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis", Int Orthop, 25, pp.360~362 (2001)
- Kim SY, "Cementless calcar- replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study", J Bone Joint Surg Am, 87, pp.2186~2192 (2005)
- Marya S, "Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly", Indian J Orthop, 45, pp.236~242 (2011)
- Parvizi J, "The Frank Stinchfield Award. Sudden death during primary hip arthroplasty", Clin Orthop Relat Res, (369), pp.39~48 (1999)
- Foster AP, "Periprosthetic femoral fractures--a comparison between cemented and uncemented hemiarthroplasties", Injury, 36, pp.424~429 (2005)
- Harwin SF, "Primary Bateman-Leinbach bipolar prosthetic replacement of the hip in the treatment of unstable intertrochanteric fractures in the elderly", Orthopedics, 13, pp.1131~1136 (1990)
- Green S, "Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly.", Clin Orthop Relat Res, (224), pp.169~177 (1987)
- Sinno K, "The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients", N Am J Med Sci, 2, pp.561~568 (2010)
- Dorr LD, "Structural and cellular assessment of bone quality of proximal femur", Bone, 14, pp.231~242 (1993)
- Kim YS, "Modified posterior approach to total hip arthroplasty to enhance joint stability", Clin Orthop Relat Res, 466, pp.294~299 (2008)
- Thomsen MN, "Fracture load for periprosthetic femoral fractures in cemented versus uncemented hip stems : an experimental in vitro study", Orthopedics, 31, pp.653~ (2008)
- Parker MJ, "Arthroplasties (with and without bone cement) for proximal femoral fractures in adults", Cochrane Database Syst Rev, 6, pp.001706~ (2010)